HB 1323 
.14 E8 
Copy 1 



INFANT MORTALITY. 



REPORT 



OF THE 



PUBLIC WELFARE COMMITTEE 

OF ESSEX COUNTY 
1912 



665 Broad Street 
Newark, N. J. 



^ Transfer 
A P* 16 1919 



^ 



0\ 



'Where the white hearse goes most often, there you 
will find the weakest places in your municipal 
housekeeping. ' ' 



'A baby who comes into the world has less chance to 
live one week than an old man of ninety ; and less 
chance to live a year than one of eighty." 



'Infant mortality is an infinitely complex problem." 



'The reduction of infant mortality is a public health 
problem. " 



' 'The time to save the baby is before it becomes sick, 
not afterward. ' ' 



the 
ity 

irk 



/ 




EVERY DOT REPRESENTS THE DEATH OF A BABY UNDER ONE YEAR OF AGE DURING SUMMER OF 1910 



By Ccu'l'V 'f»" •»"<■•""' M ° p C °- 



/ 



Special report of the work carried on by the 
Public Welfare Committee of Essex County 

for the 

Reduction of Infant Mortality in Newark 

together with 

A study of the problem in Essex County and 
a program for the City of Newark. 

By 
JULIUS LEVY, M. D. 



TRUSTEES. 

FRANK H. SOMMER, President 

S. Ervin Manness, Vice-President Emily S. Hamblen, Secretary 

John L. Rankin, Treasurer 
M. N. Baker Dr. Laban Dennis 

Edward Blau Rabbi Solomon Foster 

Dr. Wm. Buermann Dr. Miriam B. Kennedy 

Mrs. G. W. B. Cushing Rev. John J. Moment 

DEPARTMENTS. 

i. Research 
Theo. D. Gottlieb, Chairman 

2. Juvenile 
Dr. Laban Dennis, Chairman 

SECTIONS. 
Research 

Health 

Dr. Julius Levy 

Infant Consultation Stations and Milk Supply 

Edward Blau 

Placing Out of Infants 

J. A. Cullen 

Matters of State Control 

J. J. Moment 

Fire Prevention 

S. E. Manness 

Labor 

Thos. J. McHugh 

Juvenile 

Education 

Achill Bippart 

Playgrounds and Recreation Centers 

Wm. S. Lamont 

Physical Environment of the School Child 

Dr. Theo. Teimer 

Commercial Recreation 

John J. Gascoyne 

Motion Pictures and Theatres 

Rev. Geo. P. Dougherty 

Illegal Employment and Entertainment of Minors 

Chas. A. MacCall 

SUB-COMMITTEES 

Legislative 

Richard D. Currier 

Publicity 

Mrs. E. Stern 



INTRODUCTION 

The purpose of this report is, first, to present a record of the Infant 
Mortality problem in Essex County, and more especially in Newark, with 
a study of some of the most important underlying causes; second, to state 
what has been learned and accomplished by the plan proposed by the 
Public Welfare Committee of Essex County, providing for infant con- 
sultation stations, the education of mothers, and the home modification 
of milk; third, to propose on the experience obtained here and elsewhere 
a plan of action commensurate with the complexity of the problem under 
consideration, a plan that, if properly carried out, will practically remove 
the infant mortality problem from private charity and philanthropy, and 
place it on a permanent and efficient basis. 

I wish to take occasion here to thank the doctors and nurses who 
have assisted me in the clinics and have worked so devotedly in the in- 
terests of the mothers and their babies; also those who by their financial 
aid and encouragement have made this experiment and study possible. 



FOREWORD. 

Of course you believe in conserving child life! 

This study and report is sent to you in an effort to transmute that 
belief into action. 

Is it too much to ask, in the name of the babies of the county, that 
little of your time needed for a careful reading? 

Be warned, at the outset that such a reading will pull at your heart- 
strings — and perhaps at your purse-strings. 

We owe the study and report especially to the now long continued 
work, in self-sacrificing spirit of service, of Dr. Julius Levy and to Mr. 
Edward Blau, Chairman of the committee directly in charge of the work 
described. 

The conclusion reached, that the problem of infant mortality can 
be most efficiently and economically met by establishing public depart- 
ments of child hygiene with broad but definite functions is that to which 
practically all have been forced, who have studied the problem. 

What of the time that must pass before the work is included among 
governmental functions, and public departments of child hygiene become 
an actuality? 

Can we in the meantime turn a deaf ear to the bitter cry of the 
children ? No ! 

The infant consultation stations now established must be maintained ; 
their work must be strengthened ; their number must be increased, and 
their sphere of activity extended ; the continued sale of pure milk, especial- 
ly for babies, at prices within the reach of those who are compelled to 
struggle to make wage and outlay meet, must be assured; visiting of 
the homes of the new-born and the education of the mothers must go on ; 
registration for wet-nurses, and homes must continue to be provided ; and 
the systematic training of midwives must be undertaken. 

Then, too, the gathering and study of data must go on. 

The campaign of education to create sentiment for the work as a 
governmental function must be pressed. 

So long as the work continues on the plane of private philanthropy 
appeal must be made to the people for financial aid. 

The appeal is now made to you. 

The study and report present facts and the results of a scientific 
study of the facts. 

This foreword may serve to re-enforce the heart interest of these 
facts. 

Won't you as you turn the last page look into the beaming faces' of 
your little ones ; then think of the little ones outside, and the homes 
unnecessarily saddened by the going out of the vital spark of some 
babe's life for want of a little knowledge ; for lack of the methods of 
care which that little knowledge would induce? 

And then — Give! 

PUBLIC WELFARE COMMITTEE OF ESSEX COUNTY, 

Frank H. Sommer, 

Chairman. 

Wiss Building, 

Broad Street, Newark, N. T. 



Infant mortality 
problem of greatest 
magnitude. 



*THE WORK OF THE PUBLIC WELFARE COMMITTEE OF 

ESSEX COUNTY FOR THE REDUCTION OF 

INFANT MORTALITY. 

The Public Welfare Committee of Essex County 
has taken up the infant mortality problem in the same 
spirit that it has studied other civic and social prob- 
lems in our county, with the same purpose to obtain 
first hand knowledge of the problem as it exists in our 
county, to become familiar with the adequacy and effi- 
ciency of existing activities and then, if it seems neces- 
sary, to evolve a plan and method of solution that will 
attempt to be commensurate with the problem and 
can be given permanence by adoption into some muni- 
cipal department. 

With this view in mind we attempted to demon- 
strate the efficiency of our plans in but limited areas, 
leaving the extension of the work to the day when 
the city shall take it over. 

Our survey of the infant mortality problem in 
Newark revealed the following facts : 

During the past decade there were more deaths 
from infants under one year of age than from tuber- 
culosis in all forms and at all ages. That is why the 
Section on Health of the Public Welfare Committee 
felt called upon to devote itself to this subject. 

While it was found that the greater part of these 
deaths occurred in about four districts, the clinics, 
hospitals, milk depots were often not in the centre 
of these districts and therefore not where they could 
do the greatest amount of good. 

It was found, further, that the doctors and nurses 
usually could not speak the language of the mothers, 
and so at best could have very little effect in eliminating 
what, I believe, is the greatest single factor in this 
problem — ignorance made hide-bound by prejudice. 

It was further found that, though modified milk- 
could be obtained at a milk depot, relatively very few 
mothers could avail themselves of it on account of the 
distance, and though certified milk has been sold here 
for more than fifteen years, practically all of the 
mothers in the districts of highest mortality were buy- 
ing very filthy store or bottle milk. The one fact, 
however, that was the most astounding of all, was that 
while there has been a reduction of infant mortality 
in Newark during the past ten years, and though 
certified milk has been introduced and a milk depot 
operated, the infant mortality from diarrheal diseases 
showed a very marked increase in the first half of the 
past decade and was actually higher at the end of the 
decade than at the beginning. The reduction of infant 



Ignorance is greatest 
single cause. 



Certified milk and 
milk depots reach 
only a small per- 
centage of the 
babies. Diarrhea 
increasing. 



* Paper read before the Pediatric Section of the Academy of Medicine of 
Northern New Jersey, October, 1912, by Dr. Julius Levy. 



mortality has been due to factors not directly influ- 
enced by milk supply and feeding. 

As a result of these and other studies and obser- 
vations, we were convinced that milk is not the great- 
est single factor in the infant mortality problem and 
that the distribution of modified milk is not the way 
to solve this complex problem. Indeed, I have long 
felt — and many other workers are voicing this same 
opinion — that the milk depot, in the first place, in- 
creases the number of artificially fed, and secondly, 
does not reach the infants that require it most — those 
with the most ignorant and indifferent mothers ; nor 
indeed when the mortality among infants is highest — 
before the third month of life. 

Our plan found its basis in the common knowl- 
edge, obtained both empirically and biologically, that 
mothers' milk is the only proper food foi infants ; 
that mothers can nurse their infants successfully in 
greater numbers and for longer periods than obtains 
to-day — that the failure to nurse wholly or partly is 
due, in large part, to ignorance, inherited prejudices 
and superstitious beliefs that are fostered by anxious 
grandmothers, ignorant midwives, and I am sorry to 
admit, indifferent doctors ; in a lesser degree to the 
equally preventable social and economic conditions of 
overwork, undernourishment, tuberculosis and other 
debilitating diseases. Our plan is nothing more than 
to try to induce mothers to accept our knowledge of 
the importance of maternal nursing and its rationale, 
of the hygiene of infancy, of the importance of ob- 
taining a clean tuberculin tested milk and then taking 
proper care of it in the home. Our method has for its 
fundamental thought that mothers can only be con- 
vinced of these somewhat recently emphasized facts 
by doctors and nurses who see the mothers frequently, 
know their customs, habits, and prejudices, speak 
their language — yes, and even their dialect. Our ulti- 
mate purpose is to conduct our work in such a manner 
that the public and the authorities will be convinced 
that infant welfare work is of such value and im- 
portance to the entire community that it shall become 
a part of the municipal activity for the conservation 
of public health. 

I will describe the work as carried out at one 
consultation station : 

As the district in which this station was opened 
was inhabited almost entirely by Italians, we obtained, 
after much difficulty, an Italian doctor and nurse to 
assist in the work. I wish to state that neither had 
any special training in pediatric work. I consider 
the ability to speak the language of the mother of most 
importance. Clinics were held twice a week, but the 
nurse was at the station every day at a certain hour 
to meet any mothers who wished additional informa- 
tion or had very sick babies. To enable mothers to 



Milt is not the 
greatest single 
factor. 



Maternal nursing 
and education are 
the two most im- 
portant factors in 
prevention. 



Doctor and nurse 
must speak native 
language of mother. 



Pure milk at rea- 
sonable price. 



Uirth records. 



Practically all 
mothers can nurse 
their infants. 



All mothers can be 
I aught to modify 
milk at home. 



obtain milk fit for infants at a reasonable price, ar- 
rangements were made with two milk companies to 
sell their nursery milk at nine cents a quart, one selling 
it from drug stores through the generous assistance 
of the druggists, and the other delivering it by wagon. 

After a little persuasive reasoning with the au- 
thorities we were permitted to copy the birth records, 
and with these in our possession our nurses were able 
to call on every baby in our district before it was two 
months and in most instances before it was one month 
old. The purpose of this early visit is to reach the 
mother while she is still nursing her infant, to explain 
the danger of giving anything in addition, to advise 
the mother to come to the station, have her baby 
weighed each week, and place herself under the direc- 
tion of the doctor. The doctor bent all his efforts to 
convince the mothers that they were nursing success- 
fully and that under no circumstances should they give 
anything to the baby without first consulting him. This 
constant emphasis on the ability of the mothers to 
nurse their infants is absolutely necessary to coun- 
teract the general impression that very few mothers 
can nurse their infants successfully for more than a 
few weeks or months, an idea for which the constant 
emphasis on milk modifications is partly responsible. 

The time comes when the infant requires addi- 
tional milk. We then introduce slowly one, two, or 
three bottles, always prolonging the maternal nursing 
as long as possible. Even when it seemed that the 
mother had very little milk and that she could not 
nurse successfully — which was much less frequently 
than the mothers claimed, and even than many doctors 
think — we did not wean, but ordered supplemental 
feeding, that is, that the baby be nursed every three 
hours and be given immediately in addition a bottle 
of milk. In this way we kept continually before the 
mothers our horror of artificial feeding and our faith 
in the wonderfully saving powers of their own nour- 
ishment. In this way I hope we will re-establish in 
the breasts of the mothers that faith in their powers 
and that high sense of duty to their infants' welfare 
thai will compel them to maternal nursing even though 
it be at the price of some social or physical disability 
— the lacteal secretion, I am convinced, is usually pres- 
ent. However, some babies must be artificially fed. 
Of course, all milk was modified at the home of the 
mothers by the mothers themselves. This may seem 
very remarkable indeed to some, but I assure you 
there is no difficulty where the method is simple, the 
instructions definite, a clean milk to hand, and the 
cases followed by doctor and nurse that speak the 
language of the mother. With the exception of a very 
few cases we required nothing but raw diluted whole 
milk, cane sugar, barley water and salt. This I would 
emphasize as the most impressive and important phase 



of our work, because in this way alone, it seems to 
me, can rational, intelligent milk modification come 
into general household and general professional knowl- 
edge, can mothers and doctors learn the cost of clean 
milk, its value and where to obtain it. The mothers 
obtain a working knowledge of an infant's capacity 
and digestion, and when they act without advice they 
will at least have some experience to guide them. In 
this work of home modification the emphasis is laid 
on clean milk, clean bottles and nipples, proper inter- 
vals, the avoidance of additional food, and not on the 
modification. Doctors and mothers must be weaned 
from the superstition that milk modification is so com- 
plex a procedure, even when most scientific, that only 
a baby specialist can understand it and only a trained 
nurse prepare it. 

Naturally, we have some grave cases of malnu- 
trition, marasmus and summer diarrhea brought to us. 
All these cases have been cared for in the homes of 
the mothers, by the mothers with the active supervision 
of the doctor and nurse. We were prompted to try 
this not only because infants under one year and suf- 
fering from nutritional disorders do very badly in all 
institutions, the mortality often rising to 30 or 40 per 
cent, in hospitals, and from 60 to 70 per cent, in infant 
asylums, and even in the worst types of cases is only 
23 per cent, in private homes, but mainly because the 
experience of handling a sick infant has such a great 
educational value for the mother. 

From time to time young infants are left without 
a mother to care for them either through death, sick- 
ness which necessitates the removal of the mother to 
the hospital, or economic conditions which take the 
mother to the shop. The first condition we have tried 
to meet by the establishment of a county registry for 
the supervision of and placing out of infants. The 
second condition by trying to explain to the hospitals 
that by admitting a nursing mother without her infant 
they are increasing sickness and death ; I am glad to 
say that our hospitals have agreed to admit babies with 
their nursing mothers. The economic necessity that 
separates mother and infant is a bit of shortsighted 
social and economic policy that must cease, whether it 
be accomplished by means of pensions, insurance, or 
an entire change of government. 

The above are the most important things we have 
tried to introduce this summer. We intend to con- 
tinue this work for a time, but in addition we hope 
to establish classes for expectant mothers to teach them 
personal hygiene, for mothers to teach them the care 
of the home and their children, for the little mothers 
who are often the caretakers of the infants and always 
have great influence in the home ; classes and training 
for midwives, but only with the purpose of showing 
the way to the educational and health departments so 



Private homes 
preferred to 
hospitals and 
asylums. 



Tensioning' of 
mothers. 
Placing: out of 
infants. 



Education of little 
mothers, mofhers 
and midwives. 



that this work will be included in their activities. 
1 will submit only a few of our statistical data: 

During the four summer months we had on record 
509 cases, of which twelve died (including every case 
even though moribund or attending only a few hours. 
This gives a mortality of 2.3 per cent. If we omit two 
cases that were moribund and died after making only 
one visit, and one a breast-fed baby that died from 
status lymphaticus, our mortality is 1.9 per cent. 

Of all the cases under one month on admission 
(9 per cent, of the total) none were in very poor con- 
dition. Of all under two months (22 per cent, of the 
total) none were in very poor condition. No babies 
that were entirely breast fed were in very poor con- 
dition. Of the babies in very poor condition 81 per 
cent, had been artificially fed, 12 per cent, partially 
breast fed, 7 per cent, on general diet. Among the 
Italian mothers in our care at one station 98 per cent. 
had been delivered by midwives, and 19 per cent, of 
all their babes born died before two years of age. 

Department of I believe we are justified in the following conclu- 

chim Hygiene sions : A high infant mortality rate is of grave mo- 

an asset to the , ° . . - rr ■ 

community. ment not only on account of the pain, sutienng, worry, 

and economic loss it entails, but particularly because 
it is an evidence of the ante-natal, neo-natal and post- 
natal environments to which those that survive are 
also exposed. The physical resistance and mental ca- 
pacity of childhood, the moral stamina of adolescents, 
are directly influenced by the health and nutrition of 
the first two years of life. If we believe that the most 
valuable asset of this community is the health and 
character of its youth, we cannot longer question the 
urgency of making the conservation of infant life a 
special function of our municipality in a department 
of child hygiene in the city, county or state. 



*f£> 



12 



* 



\ 



' 




EVERY DOT REPRESENTS THE DEATH OF A BABY UNDER ONE YEAR OF AGE DURING SUMMER OF 1910 



By Courtesy of the Interstate Map Co. 



i 



Our Problem 




BORN WITH A HANDICAP. 




IMPROPERLY CARED FOR AFTER BIRTH. 



13 



THE EXPERIMENT. 

A statement of the work carried on by the Committee during the 
summer of 1912. 

Infant Consultation Stations — 

147 Seventh Avenue — Fifteenth Ward. 
226 Hunterdon Street (closed Oct. 1st), Fourteenth Ward. 
Beth Israel Hospital — Third Ward. 

Ferry and Richards Streets (open only one month), Tenth Ward. 
Number babies visited from birth records before one month old. . 497 
Number babies visited from birth records over 1 month and under 

2 months ■ • • • 200 

Average gain per week of babies artificially fed on home modified 

milk ' ' 4 oz. 

Number of babies registered at clinics 509 

Number of babies died 

.Mortality rate 2.3% 

Mortality rate, omitting babies under observation less than two 

weeks (7) 0.9' \ 

Mortality among children under 2 years of age, of same mothers, 

prior to opening of clinic 13.9 

Number of visits to clinics 1,549 

Largest number attending clinic any one day 40 

Average attendance 15 

Number clays by physicians at clinics 96' 

The clinics are held twice a week at each station. 

The nurses connected with each station are of the same nationality 
as the people of the district and speak their language. 

The doctors, to a considerable extent, also speak the language of the 
people. 

NURSES. 
Number of nurses — one head nurse, three in field : two speak Italian, one 
speaks Polish and Yiddish, Slavic and Russian. 

Visits to homes for registered babies 3,033 

Visits to homes for new born babies 697 

Visits to homes for instruction in home modification of milk. . . . 766 



Total 4,496 

Average visits per nurse per field working clay (6 working hours) 12 

Average visits for each baby 6 

Total working days 252 

Divided as follows : 

Days spent in visiting 141 

Hours spent in clinics, 440, or days 55 

Hours spent at stations ( 1 hour daily) 28 

Hours spent at lunch ( 1 hour daily) 28 

Number of babies registered at each station, from June 10 to Oct. 1 : 

Total. Under care Oct. 1st. 

147 Seventh Avenue 208 168 

226 Hunterdon Street 154 119 - 

Beth Israel Hospital 127 122 began July 15th 

Ferry and Richards Streets. ... 20 one month only. 

From published reports about 500 babies are cared for by other 
agencies. This is about 5 per cent, of the total births. In New York 
in 1911 about 50 per cent, of the total births were under supervision. Of 
the 10.000 babies born each year in Newark, at least 3,000 babies ought 
to be under supervision. 

14 



MILK. 

On account of the quality of the general milk supply and the price 
of certified milk in Newark, it was necessary, by special arrangement, to 
obtain milk both fit for infants and reasonable in price. 

All milk used was kept under observation by the Board of Health 
and was bought by the mothers themselves from delivery wagons or from 
drug stores, at nine cents a quart. This milk is sold regularly at twelve 
cents and fourteen cents a quart, and had a bacterial count from 10,000 
to 30,000 per C. C. 

This arrangement was made only in the districts where our stations 
are located, but many mothers, who did not attend the stations, bought 
the milk. 

Number bottles sold from drug stores, 23,023, equal to 161,161 feedings 
Number bottles delivered to house, 4,947, equal to 34,629 feedings 



Total, 27,970 " " 195,790 

Number drug stores assisting 14 

Largest number quarts sold in one week 1,168 

Average number quarts sold per day 138 

Largest number from one drug store per day 17 

This method of supplying clean tuberculin-tested milk at a reasonable 
price can be quickly applied everywhere no matter what the character of 
the general milk supply may be. 

It brings the best milk quickly and surely where most needed, without 
charity or special private effort. In this way every baby can receive pure 
milk. 

MATERNAL NURSING. 

Relation of method of feeding to condition of babies. 

Good Fair Poor Very Poor 

% % % % 

Breast 87 11 2 

Partially breast 67 24 . 7 2 

Artificial 42 31 14 13 

Nursing infants rarely suffer from malnutrition or from any other 
diseases during the first year. 

Relation of method of feeding to Diarrhea. 

Diarrhea 
Present Absent 

Breast fed only 25% 75% 

Partly breast fed 54% 46% 

Artificially fed 51% 49% 

Diarrhea is present in a large number of breast fed babies on account 
of too frequent feeding and improper handling. 

Diarrhea was present in more than one-half of those partially breast 
fed, on account of too frequent feeding and over feeding. Even mothers 
who nurse their infants require advice and instruction. 

Reports from Birmingham, England, for 1909, showed that of 1,242 
babies that died from diarrhea only ten per cent, were breast fed. 

Babies fed otherwise than on the breast die from diarrhea at twenty- 
seven times the rate that breast fed babies die. 

The true solution of infant mortality lies in breast feeding, plus 
supervision. Society cannot afford to permit industrial, social, or 
economic conditions to prevent maternal nursing. 

IS 



PROPORTION AT CERTAIN AGES THAT ARE BREAST FED, 
PARTLY BREAST FED OR ARTIFICIALLY FED. 

Relation of age to method of feeding. 
Age. Breast Partly Artificially 

1 to 4 weeks 85% 10%' 5% 

5 to 8 weeks 71 % 23% 6% 

9 to 12 weeks 68% 14% 18% 

13 to 24 weeks 50% 29% 21% 

24 to 52 weeks 10% 46% 44% 

This gives the feeding as it existed, when the babies came to the 
consultation station. 

Even at one month 10 per cent, were partly artificially fed, and 5 
per cent, entirely artificially fed. 

At two months 23 per cent, were already receiving the bottle in part, 
and 6 per cent, entirely. 

This is, practically speaking, entirely preventable, as can be seen from 
figures gathered by Dr. Herman Schwartz, director of the Pediatric 
Department of Dr. Hill's Maternity Clinic, New York. Of 1,500 mothers 
he found only four who could not nurse, when encouraged by proper 
care and advice at and after the confinement. 

Of these 1,500 mothers. Of our 509 mothers. 

96.9% nursed 1 mo. 95% nursed 1 mo. 

89.1% " 3 " 81% " 3 " 

77% " 6 " 79% " 6 " 

Notwithstanding many statements to the contrary practically all 
mothers can nurse their babies. 

He further shows the effect of careful supervision from birth on 
maternal nursing. 

Of 44 mothers who nursed a previous child months : 
10 nursed the child under clinic care 8 months 
9 nursed the child under clinic care 6 months 
5 nursed the child under clinic care 5 months 
4 nursed the child under clinic care 4 months 
9 nursed the child under clinic care 3 months 
4 nursed the child under clinic care 2 months 
3 nursed the child under clinic care 1 month 
In the Public Welfare clinics we succeeded in inducing mothers, who 
were giving the bottle only, to partly nurse, and many that were partly 
nursing to breast feed only. But to accomplish all that is possible in this 
direction we must see the babies in the first week and the mothers before 
the babies are born. This is the most important work, from every point 
of view, for the welfare of babies and the reduction of infant mortality. 
It requires much prompter return of birth records, and makes it desirable 
that the vital statistics be in the hands of those whose duty it is to 
conserve infant life. This is not the case in Newark to-day. 

INFANT CONSULTATION STATIONS vs. MILK DEPOTS. 

The efficiency of stations is determined by the age of babies attend- 
ing. Of the babies registered at the Infant Consultation Stations 9 per 
cent, were under one month of age and 22 per cent, under two months. 
Most babies attending milk depots are over three months of age. Only 
14 per cent, of the babies attending the New York Milk Committee milk 
depots were under two months. Since one-half of the babies dying in 
the first year die before three months of age, it is clear that not much 
can be accomplished unless they are reached soon after birth. 

16 



RELATION OF AGE TO CONDITION. 



Age Good 

% 

1 to 4 weeks 87 

5 to 8 weeks 78 

9 to 12 weeks 84 

13 to 18 weeks 83 

19 to 24 weeks 74 

25 to 36 weeks 64 

37 to 52 weeks 65 

52 weeks 51 



Fair 


Poor 


Very poor 


% 


% 


% 


9 


4 





18 


4 





2.3 


9 


4.7 


3 


8 


6 


11 


11 


4 


26 


2 


8 


26 


7 


2 


38 


5 


6 



In the first two months, 82 per cent, were in good condition, none in 
very poor condition. 

Between two and six months, 72 per cent, were in good condition, 
5 per cent, in very poor condition. 



The figures point to the importance of prompt supervision from birth 
and of the desirability of a prompt notification act so the babies can be 
visited soon after birth. In this way only can we prevent early weaning, 
improper feeding, summer diarrhea and malnutrition. To accomplish this 
the birth records must be, in fact, as supposed to be in law, in the hands 
of those requiring them within five days after birth. 



MORTALITY RECORD OF CHILDREN UNDER TWO YEARS 
OF AGE PREVIOUS TO MOTHERS' ATTENDANCE 
AT CONSULTATION STATIONS AND PRO- 
PORTION DELIVERED BY MIDWIVES. 

Deaths -„ „ ,. , 

under Mor " Delivered 

Mothers Births years tality by 

of aee rate midwife 

Seventh Avenue (Italian) 206 476 95 19% 98% 

Hunterdon Street (Italian and 

mixed) 154 468 55 12% 91% 

Beth Israel Hospital 126 363 37 10% 56% 

Ferry Street (Slavic) 19 61 11 18% 74% 

The highest mortality was found among the Italians in the Fifteenth 
ward. Here, almost all the women are confined by midwives. Practically 
all of these carry on factory labor in the home. Most of those under our 
observation know very little of infant hygiene and the general rules of 
health. 

Of all the babies born to the 509 mothers before they attended the 
clinics thirteen per cent, died before reaching their second birthday. Of 
the same mothers only 2.3 per cent, of the babies under the care of the 
infant consultation stations died during the summer. Supervision alone 
causes a reduction in infant morbidity and mortality. 

i7 




i8 



DATA CONCERNING THE TWELVE FATAL CASES. 

If we omit the two cases of syphilis and one case of Status Lymphati- 
cus, all clearly beyond our influence, our mortality was 1.9%. If we 
omit, in additon, all cases that were under our care less than four days, 
the mortality is reduced to 1.1%. If we omit those under observation 
less than nine days, the rate would be 0.9%. 

Of the twelve fatal cases, only one at the outset of summer was 
breast fed and in good condition. This infant died from an irremediable, 
inherent defect. 

Of the remaining eleven, three were in fair condition and eight in 
poor or very poor condition, and before the hot weather had set in were 
from ten per cent, to fifty per cent, under weight. Two had been arti- 
ficially fed from birth and eleven had been artificially fed after the first 
month. 

Four of the twelve that died were without mother's care ; of these 
two were legitimate and two illegitimate. Of the former, one mother 
died and one worked in a factory ; of the latter, one mother deserted and 
one worked in a factory. 

The above facts show clearly that many factors other than milk and 
summer heat bring about the death of infants. These factors can be 
classed as social and economic rather than hygienic and sanitary. Fur- 
thermore, the}' prove that babies dying from summer diarrhea have been 
suffering from improper care and feeding before the summer began. 
Therefore, work must be conducted all year around and not during the 
summer alone. 

Above all, these cases show that for one reason or another, personal, 
social or economic, the babies were deprived of the breast and often of 
the mother's care as well. When this takes place the legitimate baby 
fares no better than the illegitimate baby. 

Of these twelve cases eleven could have been saved, first, by pre- 
vention or prompt cure of hereditary syphilis ; second, by active super- 
vision of the babies immediately after birth so that they would have been 
nursed and properly cared for ; third, by the keeping of mother and baby 
together, whether legitimate or illegitimate. 

EXPENSES JUNE TO OCTOBER, 1912. 

Salaries of head nurse and two nurses $860.00 

One nurse is paid by the Board of Health. ($65.00 per month.) 

Expenses of nurses for sundries 30.39 

Signs, index cards, charts 66.00 

Furnishing of three Stations 24.00 

Literature distributed 27.85 

Equipment of Stations — scales, repairs, etc 20.25 

$1,028.49 

Owing to the hospitality of churches in the clinic neighborhoods, 
there was no expense for rent. 

Omitting the salary of the head nurse, the cost per baby, for the 
time actually devoted to it alone would be $1.10 for four months, or 
$.0130 per baby per clay for nurse. 

Costs about $4.00 a year to keep a baby alive and well. 

Costs about $50.00 to bury it. 

19 



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STUDY. 

STATEMENT OF THE PROBLEM OF INFANT MORTALITY 

IN NEWARK AND ESSEX COUNTY. 

TABLE 1. 

Number of deaths under one year for period 1901-1910 and in 1910. 

1910 1901-1910 

Newark 1,232 10,703 

Orange 100 1,030 

Montclair 94 843 

East Orange 45 422 

Belleville 41 250 

Bloomfield 26 319 

Iryington 26 177 

West Orange 24 189 

Essex County 1,631 14,457 

TABLE 2. 

INFANT MORTALITY RATES : 

PROPORTION OF DEATHS UNDER 1 YEAR OF AGE TO 1,000 

BIRTHS. 

1910 1901-1905 1905-1910 

Newark 123 155 130 

Orange 119 156 126 

Montclair 200 305 161 

East Orange 75 110 87 

Belleville 220 

Bloomfield 90 190 132 

Irvington Ill 127 107 

West Orange 96 119 92 

Essex County 121 157 128 

Essex County (less 8 cities) ... ... 100 

TABLE 3. 
PROPORTION OF DEATHS UNDER ONE YEAR TO TOTAL 

DEATHS. 

Newark 20.3 Belleville — 

Orange 20.0 Bloomfield 21.4 

Montclair (Infant asylum Irvington 18.5 

present) 30.9 West Orange 20.0 

East Orange 15.4 Essex County — 

TABLE 4. 

PROPORTION OF DEATHS UNDER ONE MONTH TO DEATHS 

UNDER ONE YEAR. 

% % 

Newark 33.2 Bloomfield 32.9 

Orange 34.7 Irvington 33.3 

Montclair 23.3 West Orange 35.9 

East Orange 41.9 Essex County 33.7 

Belleville 36.4 Essex County (less 8 cities) 

(Rural) 40.3 

TABLE 5. 
INFANT MORTALITY IS THE HEALTH PROBLEM OF 

GREATEST MAGNITUDE IN ESSEX COUNTY. 
Year 1910 Infants Tuberculosis 

Essex County 1,631 1,122 

Newark 1,232 831 



The number of deaths from tuberculosis at all ages and in all forms 
is less than the number of deaths among infants under one year of age. 

These tables show the great number of infants that die before they 
reach the age of one year. It exceeds all deaths from tuberculosis in all 
forms at all ages. Tt forms approximately one-fifth of the total number 
of deaths. In most cites one-third of all deaths under one year occur in 
the first month of life. 

In cities where infant mortality is low it will be found that it can 
be further reduced by attacking the factors influencing death in the first 
month. 

In East Orange 41 per cent, of deaths under one year of age are due 
to deaths under one month. 

It is the unanimous opinion that at least 50 per cent, of the deaths 
under one year are preventable. The preventable deaths represent con- 
ditions in which the surviving infants must continue to live. Many die 
in the second or third year, others carry their malnutrition and physical 
defects into school, industrial and family life. A conservative estimate 
can place this preventable loss in life, health, and general efficiency in the 
County of Essex alone at $100,000 a year. 

INFANT MORTALITY RATE IN NEWARK, 1901-10. 
Deaths under one year per 1,000 births. 









Certain Groups 


of Diseases 




Year 


Rate 


Respiratory 


G astro 

Intestinal 


Congential 
Debility 


All 
Others 


1901 


160 










1902 


163 


30.3 


29.1 


38.7 


64.7 


1903 


151 


24.6 


30.0 


48.2 


48.2 


1904 


162 


27.9 


43.6 


38.6 


51.9 


1905 


141 


22.9 


43.4 


40.2 


28.5 


1906 


143 


28.8 


46.7 


46.3 


21.2 


1907 


138 


18.5 


43.1 


40.5 


37.9 


1908 


133 


23.3 


55.5 


38.6 


26.6 


1909 


115 


19.9 


34.4 


38.8 


21.9 


1910 


123 


25.4 


34.4 


34.0 


29.1 


, ( 1902-05 
Average ll906-10 




26.4 


36.5 


41.4 


48.3 




23.1 


40.6 


39.6 


37.3 



There has been a positive reduction in infant mortality in Newark 
in the past ten years. What has caused it? 

PROPORTION OF DEATHS UNDER ONE YEAR DUE TO 
DEATHS FROM DIARRHEA. 



1903. 



17.5 1 10 , 1906 37.3 | 

igy\ average 18.6 ^gQJ 39 7 j- average S/.i> 

1904 25.7/ 0<70 1908 32.4 j „ , 

1905 28.7 \ avera g e 2/ - 2 1909 30.0 f avera g e 301 

1910 28.0 



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The tables show that the proportion of deaths under one year due to 
diarrhea have increased 46.2 per cent, in 1904-5 over 1902-3, 101.5 per 
cent, in 1906-7 over 1902-3, 61 per cent, in 1908-10 over 1902-3. 

That the reduction of infant mortality in Newark has been due to a 
reduction in the number of deaths from those diseases other than those 
classed under respiratory, gastro-intestinal, and congenital debility ; 
namely, to the acute contagious diseases, meningitis, tuberculosis, syphilis, 
convulsions, diseases of the heart and kidneys, which showed a rate of 
29.1 in 1910 against 64.7 in 1902. 

In the period 1906-10 there was an actual increase in the deaths due 
to diarrhea over 1902-06. There has been a very -slight decrease in those 
due to congenital debility and respiratory diseases. 

While there has been a reduction in Newark in the infant mortality 
rates, it is clearly not due to the activities established in Newark with 
the hope of influencing deaths from contaminated milk and summer 
diarrhea. In truth there has been an actual increase in deaths due to 
diarrhea. 



THE AGE OF THE INFANT IS OF FAR GREATER IMPOR- 
TANCE THAN THE QUESTION OF SUMMER HEAT OR 
SUMMER DIARRHEA. 

Newark, 1910. 

Proportion Number and proportion 

Total number of Number of deaths of d eat hs of deaths under 3 mos. 

deaths under dunnt' June, July, during- of age to deaths under 

1 year of age Auir.. Sept. Summer one year 

1242 497 40% 660; 53.1% 

During the summer period of four months, that is one-third of the 
year, 40 per cent, of the babies died, while during the first three months 
of life, that is one-fourth of the first year, more than 50 per cent, of the 
babies died. 

Age Incidence of deaths in the first year 

Total number of deaths under: 
1 clay 1 week 1 month 2 months 3 months 1 year 
140 285 456 560 660 1242 

Of the deaths under one year, 11.2 per cent, occur on the first day, 
22.9 per cent, in the first week. 36.7 per cent, in the first month, 45 per 
cent, in the first two months, 53.1 per cent, in the first three months. 

Of the deaths in the first month, 36.7 per cent, of the total under one 
year, only 6 per cent, are ascribed to diarrhea. 

These tables clearly direct our attention to conditions affecting infant 
life and death, acting before, at, or immediately after the birth. 

Contaminated milk and summer diarrhea are not the most important 
factors in infant mortality. 

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The infant mortality is not evenly distributed through the first year. 

Newark, 1910. 

PROPORTION OF DEATHS AT CERTAIN AGES PER 1,000 

BABIES OF SAME AGE. 

Under 1 week.. 28.4 Under 1 month. 45.4 Under 1 year... 123 

First day 13.9 First week 7.29 One month 10.8 

Second day 5.05 Second week... 5.48 Two months. . ..10.5 

Third day 2.74 Third week 4.88 Three months.. . 9.6 

Fourth day 2.64 Four months. . . 7.97 

Fifth day 1.92 Five months. ... 8.8 

Sixth day 1.14 Six months 7.5 

Seventh day. .. . 1.22 Seven months .. . 6.07 

Eight months. . . 7.0 
Nine months... . 6.6 
Ten months. . . . 5.2 
Eleven months . . 4.7 

The greatest infant mortality is on the first day. It steadily decreases 
to the end of the year. As many deaths occur in the first week as in the 
second, third and fourth months combined. Almost as many deaths occur 
on the first day as in the last three months of the first year combined. As 
man)' deaths occur in the first month as in the next five months combined. 

Any plan that would reach the babies at their most critical period 
must control the conditions that cause the high infant mortality in the 
first days, namely, the health of the mothers, diseases of parents, lying-in 
care, maternal nursing. 

Prenatal and neonatal care are probably equally important with post- 
natal care, and can be made equally effective. 



EFFECT OF CARE OF THE FOUNDLING, DEPENDENT AND 

MOTHERLESS INFANTS ON INFANT MORTALITY. 

*Infant Mortality in Infant Asylum (Montclair). 



Years 


Infants 
Admitted 


under 1 year 
Died 


Mortality 

rate per 

1000 

admissions 




1901 


67 


43 


640 




1902 


80 


60 


750 




1903 


101 


73 


720 




1904 
1905 


89 
84 


65 
57 


730 
670 


/ Average for ten years, 
( 68 per cent, of all babies 


1906 


51 


32 


620 


) admitted under one year 


1907 


38 


28 


730 


died before reaching their 


1908 
1909 


8 
56 


6 

27 


750 
480 


\ first birthday. 


1910 


51 


35 


680 




1911 


56 


26 


460 





*Figures furnished by Health Officer of Montclair. 



Influence of Infant Asylum on Infant Mortality 

Rate of Montclair, N. J. 

1901—1910 



400 



350 



300 



250 



200 



150 



100 



50 





























































































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fnfont / 


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300 



250 



200 



150 



100 



{ 50 



1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 



INFLUENCE OF INFANT ASYLUM ON THE INFANT MOR- 
TALITY RATE OF A CITY (MONTCLAIR). 

Infant mortality rate in Montclair, with deaths in Infant Asylum. 

Included Omitted 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

1908 

1909 

1910 



278 " 


" 137 


305 " 


" Ill 


385 " 


" 167 


282 " 


" 116 


178 " 


" 92 


173 " 


" 109 


109 " 


" 82 


140 " 


" 82 


200 " 


" Ill 



Average infant mortality rate for ten-year period in Newark, 142.9; 
Infant Asylum in Montclair, 680. 



INFLUENCE OF FARMING OUT BABIES ON INFANT MOR- 
TALITY, NEWARK, SUMMER OF 1910. 

Number of deaths under one year of age in Sixteenth ward, 13 ; 
baby farm in same ward, 6. 

During the summer of 1910 of all the babies under one year of age 
that died in the Sixteenth ward, 46 per cent, died in a home that was 
receiving babies for board. 

In Montclair in some years 60 per cent, of all deaths under one year 
occur in an infant asylum. 

In London in the Foundling Hospital the mortality of children under 
five years at one time was 69 per cent. Now the children of the same 
class are placed out until five years of age, and so in 1910, out of 260 
children boarded out in private homes only four died. 

In New York, 42 per cent, of all the deaths under one year occurred 
in hospitals and institutions. In one foundling institution, out of 2,440 
births and admissions, 1,275, or 52 per cent., died before reaching one 
year of age. 

From the above figures one must conclude that infant asylums, hos- 
pitals and baby farms are not good places for babies. 

Mr. Claude Wright, the general secretary of Dr. Bernado's Homes, 
which is the largest charity in England dealing with infants, says : "Our 
experience leads us to the conclusion that a large segregation of babies 
under one roof is fatal to their well-being and health, however carefully 
and well they may be looked after. Therefore, all babies that come under 
our care are boarded out immediately." 

Dr. S. Josephine Baker, chief of Department Child Hygiene, New 
York, says: "While it is recognized that many of the babies received 
at these institutions are in poor physical condition and often even mori- 
bund, yet investigations have shown that it is possible to greatly reduce 
the mortality among this class of babies if they can be placed out to 
board in properly inspected and supervised private homes." 



HOUSING AND CONGESTION. 

Housing and congestion must have a marked effect on health. It 
has been an accepted fact that the highest infant mortality was found in 
the most congested districts of a city. Recently it has been shown that 
during the summer the infant mortality is very much influenced by the 
temperature, moisture, and ventilation of the living rooms ; it was found 
in Berlin that the mortality of babies living in the upper floors of tenements 
was higher than of those living lower down. It is interesting to note 
that in Newark the greatest density and congestion is found in the wards 
showing the greatest infant mortality. 

Newark, 1910. 

Number of persons to occupied area: Number of persons to dwelling. 

Wards 

14 126 10.47 

3 123 11.83 

15 98 9.08 

5 86 9.17 

Whole city 40 8.09 

These are the wards where the greatest number of babies die in the 
city of Newark. Here is the greatest need for "breathing spaces," little 
bits of parks, so that the babies can be taken out of the superheated 
tenements during the summer. Here is where the tenement house laws 
need to be enforced most .vigorous!}'. 



MIDWIFERY. 

Eighty-five midwives registered in Newark since 1895 ; 135 midwives 
were practicing in November, 1912. 

Proportion of mothers delivered by midwives — 

Newark 52% Montclair 13-18% Orange 36% 

Proportion of mothers delivered by midwives, by nativity — 
Newark, 1912 — summer. 

Italian 83% Russian 60% 

Austrian 82% German 48% 

Hungarian 73% Native 25% 

Midwives are a very important factor for good or for evil in the early 
life of infancy, and should be carefully supervised by the authorities'. 



NUMBER OF HOSPITAL BEDS IN ESSEX COUNTY. 





For 


For 




Maternity 


Children under three 




cases 


years of age 




37 


66 


Orange 


8 


6 




4 





Six per cent, of all babies born during the summer of 1912 were born 
in the hospitals of Newark. Very little lying-in facilities in the hospitals 
of Essex County. Midwives deliver most of the mothers where infant 
mortality is highest. 



29 



CHARACTER OF INFANT POPULATION BY NATIVITY OF 

MOTHERS. 

Three thousand one hundred and thirty-five infants were born from 
June to October, 1912, in Newark, N. J. 

Nativity of Mothers. 

833 Italian 26.0%, 129 German 4.1% 

333 Austrian 10.6% 1342 Native 42.0%. 

144 Hungarian 4.5%. 176 English, Irish, Scottish 5.2% 

452 Russian 14.0%. 126 Miscellaneous 4.1%. 

While 47 per cent, of the babies were born of native, English, Irish 
and Scottish mothers, only 38% of the children dying under two years 
were of native, English, Irish and Scottish mothers. 

Fifty-eight per cent, of babies born during the four months — June, 
July, August and September — have foreign-born mothers. 

Less than 50 per cent, of the babies born in Newark have mothers 
whose native tongue is English. 

Twenty-six per cent, have mothers who can be effectively educated 
in infant hygiene in Italian only. 

Twenty-nine per cent, have mothers who can be effectively educated 
in infant hygiene in Polish, Russian or Yiddish only. 

Since education is the very kernel of all effective plans for the 
reduction of infant mortality, it is apparent that if this work is to be done 
effectively in Newark we must have doctors "and nurses who can speak 
the language of our various foreign elements. In work previously carried 
on here and elsewhere, this phase has not received the emphasis that it 
deserves. 

CONCLUSIONS. 

Infant consultation stations are less expensive and more efficient 
than milk depots. 



All mothers can be taught to prepare milk for their infants at home. 



Pure milk can be obtained for babies at a price within reach of all. 



The mortality of infants under one year of age is exceedingly high 
in all institutions'. 



Infants deprived of mother's care should be placed out in properly 
supervised private homes. 



Ignorance is the greatest single factor in infant mortality. 



Education of mothers and the supervision of babies cause the great- 
est reduction of infant mortality. 



The prompt and accurate notification of births' is necessary to enable 
us to prevent the great mortality of the first week of life. 



Midwives can become a great force in the education of our foreign 
born mothers in infant hygiene through active and careful supervision. 



The reduction of infant mortality can best be accomplished by 
the establishment of a municipal department of child hygiene. 



30 



DEPARTMENT OF CHILD HYGIENE BY MUNICIPALITIES, 
COUNTY OR STATE. 

Functions. 

The functions of such a department should be: 

A. Care of new-born. 

1. Securing of all birth records within 5 days. 

2. Providing of pure milk for infants. 

3. Establishing infant consultation stations. 

4. Visiting of new-born. 

5. Education of mothers in the care of infants. 

B. Control and supervision of midwives. 

C. Registry for and supervision of placed out infants. 

D. Inspection of institutions harboring dependent children. 

ARGUMENT. 

Civilized society has accepted the responsibility of caring for the 
health of all its members. While in the beginning communities had to 
content themselves with the mere care and control of disease on account 
of ignorance of the fundamental etiological factors in disease, our health 
authorities at the present time are able and anxious to prevent those 
conditions that are known to lead to lower resistance, ill health, disease 
and general inefficiency. The prevention of disease is easier and cheaper 
than its treatment and cure. 

No one condition, no one period of life is as important to the future 
health of the community as infancy. The health, vigor, industrial effi- 
ciency and moral stamina of our citizens are influenced by their early 
environment and care. The governments of Europe are deeply interested 
in their birth rates and infant mortality rates, and are spending much 
thought and money for child welfare, because, it is said, they need 
soldiers. I am sure we cannot afford to be less concerned, for we need, 
above all else, sane, healthy, well-balanced, efficient, self-supporting 
citizens. 

Thousands upon thousands of dollars are spent for moral, secular, 
and industrial education for children who are unable to profit from it on 
account of physical and mental defects that result directly from improper 
and insufficient care during infancy. Abscences from school, retardation 
and backwardness, classes for anemic and tubercular children, would all 
be considerably lessened by active supervision of children under school age. 

While much has been accomplished by the present methods of con- 
trolling the spread of tuberculosis, the most brilliant results are to be 
expected from activities that will improve the nutrition and increase the 
resisting powers of the children. 

Finally, modern society cannot knowingly and needlessly permit these 
little ones to suffer and to die, and remain true to its trust and respon- 
sibilities. 

For these reasons we feel that it is the duty of the city and state 
to adopt some such plan as is outlined above, so that each infant will 
have a fair opportunity for life and happiness. The expense entailed 
should be looked upon as an investment that would repay the community 
many times in lives saved, sickness prevented, and a general increase in 
economic, educational and moral efficiency. The money for this depart- 
ment would, properly speaking, come from a redistribution of expen- 
ditures. 

3i 



COST OF DEPARTMENT OF CHILD HYGIENE. 

A department could be established in Newark for $8,500. It would 
supervise the care of 3,000 infants. It would cost approximately three 
dollars a year to supervise the care of one baby. 

The expenses would be distributed as follows : 

Three j One Director $1,200 

Physicians | Two physicians for stations 1,000 

Six nurses 4,680 

Six stations, in schools 

Printing 500 

One clerk 750 

Equipment 500 

Incidentals 20 

Total $8,500 

Infant consultation stations are most urgently needed in the centre 
of the congested districts in the Fifth, Tenth, Twelfth, Fourteenth, Fif- 
teenth and Third wards. They should be located near — 

Character of 
neighborhood 

Seventh avenue and Factory street, in the Fifteenth ward Italian 

Fourteenth avenue and Newton street, in the Fourteenth ward. . . .Italian 
Prince and West Kinney streets in the Third ward. . . .Russian and Polish 

Pacific and Oliver streets, in the Twelfth ward Italian 

Adams and Downing streets, in the Fifth ward Italian and Polish 

Ferry and Richard streets, in the Tenth ward. . . . Polish, Russian, German 

Of the six nurses, three should speak Italian and three Slavic 
languages. One doctor should speak Italian and one doctor Yiddish and 
Slavic. 



i 



LIBRARY OF CONGRESS 



013 825 288 7 * 



